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Home My WebLink About2255 French Creek Circle Septic certM MINNESOTA POLLUTION Compliance inspection report form CONTROL AGENCY 520 Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS) St. Paul, MN 55ISS-4194 Doc Type: Compliance and Enforcement Instructions: Inspector must submit completed form to Local Governmental Unit (LGU) and system owner within 15 days of final determination of compliance or noncompliance. Instructions for filling out this form are located on the Minnesota Pollution Control Agency (MPCA) website at https://www.pca.state.mn.usisites/default/files/wa-wwists4-31a.pdf, Property information Local tracking number: Parcel ID# or Sec/Twp/Range: 1011723320006 _ _ Reason for Inspection Propery Transfer Local regulatory authority info: City of Orono Property address: 2255 French Creek Circle Owner/representative: William Brann Brief system description: 3-1000-gallon septic tanks, records. System status System status on date (mm/ddlyyyy): 12/3/2024 ® Compliant — Certificate of compliance Owner's phone: 952-210-6167 1-1500-gallon lift station and 750 square feet of mound rock bed per city (Valid for 3 years from report date unless evidence of an imminent threat to public health or safety requiring removal and abatement under section 145A.04, subdivision 8 is discovered or a shorter time frame exists in Local Ordinance.) *Note: Compliance indicates conformance with Minn. R. 7080.1500 as of system status date above and does not guarantee future performance. ❑ Noncompliant — Notice of noncompliance Systems failing to protect ground water must be upgraded. replaced, or use discontinued within the time required by local ordinance. An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance or under section 145A. 04 subdivision 8. Reason(s) for noncompliance (check all applicable) ❑ Impact on public health (Compliance component #1) — Imminent threat to public health and safety ❑ Tank integrity (Compliance component #2) — Failing to protect groundwater ❑ Other Compliance Conditions (Compliance component #3) — Imminent threat to public health and safety ❑ Other Compliance Conditions (Compliance component #3) — Failing to protect groundwater ❑ System not abandoned according to Minn. R. 7080.2500 (Compliance component #3) — Failing to protect groundwater ❑ Soil separation (Compliance component #5) — Failing to protect groundwater ❑ Operating permit/monitoring plan requirements (Compliance component #4) — Noncompliant - local ordinance applies Comments or recommendations This system is designed for a six bedroom house. There is 1.0 feet of sand under the rock bed found. TBM: Bottom of rock bed. ELV.-107.2 Included are the original borings. Certification 1 hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. By typing my name below, 1 certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing this form. Business name: Rusty Olson Soil & percolation Testing Inspector signature: Joseph J. Olson (This document has been electronically signed) Certification number: C1255 License number L810 Necessary or locally required supporting documentation (must be attached) Phone: 763-498-8779 ® Soil observation logs ® System/As-Built ❑ Locally required forms ® Tank Integrity Assessment ❑ Operating Permit ❑ Other information (list): https://www.pca.state.mn.us wq-wwists4-31b • 412812021 • 651-296-6300 • 800-657-3864 Use your preferred relay service • Available in alternative formats Page 1 of 4 Property Address: 2255 French Creek Circle Business Name: Rusty Olson Soil & percolation Testing Date: 12/3/2024 1. Impact on public health — Compliance component #1 of 5 Compliance criteria: System discharges sewage to the ❑ Yes" ®No ground surface System discharges sewage to drain ❑ Yes` ® No tiie or surface waters. System causes sewage backup into ❑ Yes' ® No dwelling or establishment. Any "yes" answer above indicates the system is an imminent threat to public health and safety. Describe verification methods and results: Visual. Nothing was found Attached supporting documentation: ❑ Other: ® Not applicable 2. Tank integrity — Compliance component #2 of 5 Compliance criteria: System consists of a seepage pit, ❑ Yes* ® No cesspool, drywell, leaching pit, or other nit? Sewage tank(s) leak below their ❑ Yes' ® No designed operating depth? If yes, which sewage tanks leaks: Any "yes" answer above indicates the system is failing to protect groundwater. Describe verification methods and results: Kothrade Sewer & Water pumped the tanks. Attached supporting documentation: ❑ Empty tank(s) viewed by inspector Name of maintenance business: License number of maintenance business: Date of maintenance: ® Existing tank integrity assessment (Attach) Date of maintenance 11/15/2024 (mmiddlyyyy): (must be within three years) (See form instructions to ensure assessment complies with Minn. R. 7082.0700 subp. 4 B (1)) ❑ Tank is Noncompliant (pumping not necessary - explain below) ❑ Other: https://www.pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service 0 Available in alternative formats wq-wwists4-31b • 412812021 Page 2 of 4 Property Address: 2255_French Creek Circle Business Name: Rusty Olson Soil & percolation Testing_ _ 3. Other compliance conditions — Compliance component #3 of 5 Date: 12/3/2024 3a. Maintenance hole covers appear to be structurally unsound (damaged, cracked, etc.), or unsecured? ❑ Yes' ® No ❑ Unknown 3b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety? ❑ Yes: ® No ❑ Unknown *Yes to 3a or 3h - System is an imminent threat to public health and safety. 3c. System is non -protective of ground water for other conditions as determined by inspector? 3d. System not abandoned in accordance with Minn. R. 7080.2500? *Yes to 3c or 3d - System is failing to protect groundwater. Describe verification methods and results: Visual. Nothing was found Attached supporting documentation: ® Not applicable ❑ ❑ Yes` ® No ❑ Yes" ® No 4. Operating permit and nitrogen BMP* -- Compliance component #4 of 5 ❑ Not applicable Is the system operated under an Operating Permit? ❑ Yes ❑ No If "yes", A below is required Is the system required to employ a Nitrogen BMP specified in the system design? ❑ Yes ❑ No If "yes", B below is required BMP = Best Management Prectice(s) specified in the system design If the answer to both questions is "no", this section does not need to be completed. Compliance criteria: a. Have the operating permit requirements been met? ❑ Yes ❑ No b. Is the required nitrogen BMP in place and properly functioning? ❑ Yes ❑ No Any "no" answer indicates noncompliance. Describe verification methods and results: Attached supporting documentation: ❑ Operating permit (Attach) ❑ https://www.pca.state.mn.us wq-wwists4-31b • 412812021 651-296-6300 • 800-657-3864 Use your preferred relay service Available in alternative formats Page 3 of 4 Property Address: _225:5 French Creek Circle Business Name: Rusty Olson Soil & percolation Testing _ _ Date: 12/3/2024 5. Soil separation — Compliance component #5 of 5 Date of installation 6/19/2017 (mm/dd/yyyy) ❑ Unknown ShorelandlWellhead protection/Food ® Yes ❑ No beverage lodging? Compliance criteria [select onej: __ 5a. For systems built prior to April 1, 1996, and ❑ Yes ❑ No' not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a two -foot vertical separation distance from periodically saturated soil or bedrock. Attached supporting documentation: ® Soil observation logs completed for the report ❑ Two previous verifications of required vertical separation ❑ Not applicable (No soil treatment area) 5b.Non-performance systems built ® Yes ❑ No* Indicate depths or elevation_ s April 1, 1996, or later or for non- performance systems located in Shoreland A. Bottom of distribution media 107.2 or Wellhead Protection Areas or serving a B. Periodically saturated soil/bedrock 104.2 food, beverage, or lodging establishment: — — C. System separation 3.0 Drainfield has a three-foot vertical - - separation distance from periodically D. Required compliance separation* 2.55 saturated soil or bedrock.* *May be reduced up to 15 percent if allowed by Local Ordinance. 5c. "Experimental", "Other", or "Performance" ❑ Yes ❑ No% systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules 7080. 2350 or 7080.2400 (Intermediate Inspector License required 2,500 gallons per day; Advanced Inspector License required > 2,500 gallons per day) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. *Any "no" answer above indicates the system is failing to protect groundwater. Describe verification methods and results: Upgrade requirements: (Minn. Stat. § 115,55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is falling to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas, Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. https://www.pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wq-wwists4-31b • 412812021 Page 4 of 4 M MINNESOI'A POLLUTION Sewage tank integrity assessment farm CONTROL AGENCY b 520 Lafayette Road North Subsurface Sewage St. Paul, MN 55155-4194 Treatment Systems (SSTS) Program Doc Type: Compliance and Enforcement Purpose: This form may be used to certify the compliance status of the sewage tank components of the SSTS. This form is not a complete SSTS inspection report, only a tank integrity assessment, and may only certify sewage tank compliance status when entirely completed and signed by a qualified professional. SSTS compliance inspection report forms can be found at: httpsalwww.oca.state. mn.uslwater/inspections. Instructions: This form may be completed, and signed, by a Designated Certified Individual (DCI) of a licensed SSTS inspection, maintenance, installation, or service provider business who personally conducts the necessary procedures to assess the compliance status of each sewage tank in the system. Only a licensed maintenance business is authorized to pump the tank for assessment. A copy of this information should be submitted to the system owner and be maintained by the licensed SSTS business for a period of five (5) years from the assessment date. When this form is signed by a qualified certified professional, it becomes necessary supporting documentation to an Existing System Compliance inspection Report: Compliance inspection form - Existing s stem (wq-wwists4-31 b). This form can be found on the MPCA website at httl2s://www.oca.state.mn.us/water/inspections, The information and certified statement on this form is required when existing septic tank compliance status is determined by an individual other than the SSTS Inspector that submits an inspection report. This form represents a third party assessment of SSTS component compliance and is allowable under Minn. R. 7082.0700, subp. 4(B)(1). This form is valid for a period of three years beyond the signature date on this form unless a new evaluation is requested by the owner or owner's agent or is required according to local regulations. Additional Administrative Rule references for this activity can be found at Minn. R. 7082,0700, subp. 4(B),(C), and (D) and-, Minn. R. 7083.0730(C). Owner information Owner/Representative William & Lizbeth Brann Property address: 2255 French Creek Circle, Orono MN 55391 Local Regulatory Authority: Cit r_of Orono T Parcel ID: 10-117-23-32-0006 System status System status on date (mrn/ddlyyyy): %� '_ It jR3Certificate of sewage tank compliance � 7— - :_1 kill ,ru , --- - ') , —� otice of sewage tank non-compliance Compliance criteria: The SSTS has a seepage pit, cesspool, drywell, leaching pit, or other pit - "Failure to Protect Groundwater." — The SSTS has a sewage tank that leaks below the designed operating depth - "Failure to Protect Groundwater." The SSTS presents a threat to public safety by reason of structurally unsound (damaged, cracked, } or weak) maintenance hole cover(s) or lids or any other unsafe condition - "Imminent Threat to Public Health or Safety." Any "yes" answer above indicates sewage tank non-compliance Company information Company name: Kothrade Sewer, Water & Excavating, Inc Business license number: L192 ❑ Yes- ;PrN- o - ❑ Yes- (;'No ❑ Yes` W No Designated Certified Individual (DCI) information Print name: Larry Bursch Certification number: C9199 I personalty conducted the work described above as a Designated Certified Individual of a Minnesota -licensed SSTS inspection, maintenance, installation, or service provider Business. I personally conducted the necessary procedures to assess the compliance status of each sewage tank in this SSTS. By typing/signing my name below, I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processin 0',s form �� f Designated Certified Individual's signature: . � Date (mm/dd/yyyy): (This documeufhas been electronically signed.) www.pca.state.mn.us 651-296-6300 800.657-3864 Use your preferred relay service Available in alternative formals wQ-wwists4-91 • 5/]0/21 Page 1 of 1 Property Owner 1 project Property Address / PID: Soil Observation Log www,SeptieResource.com vers 12.4 Owner Information William Brann 2255 French Creek Circle Date 12/3/2024 Soil Survey Information ❑ refer to attached soil survey Parent matl's: 0 Till ❑ Outwash ❑ Lacustrine ❑ Alluvium ❑ Organic ❑ Bedrock landscape position: ❑ summit ❑ Shoulder p Side slope ❑ Toe slope soil survey map units: LbUB slope % direction - Soil Log 41 l] Boring ❑ pit Elevation 106.2 Depth to SHWT 24 Inches Depth (in) Texture fragment % matrix color redox color consistence grade shape 0-14 Loam 10yr3/1 Friable Strong Blocky 14- i 8 Clay Loan, : --35 10yr4i3 Friable Strong Blocky 18-24 Clay Loam < 3 � 10yr5/4 Friable Strong Blocky <35 loose loose single grain 35 - 50 friable weak granular blocky >50 firm moderate prismatic platy rigid strong massive <35 loose loose single grain 35 - 50 friable weak granular block firm moderate prismatic plat} >50 rigid strong massive Comments: TBM: Basement door threshold. ELV.-100.0 Soil Observation Log tit. u.SmicResource.com very 12.4 Owner Information Property Owner i project: Jim Broueek Date 4/11 /2017 Property Address.' PID: 2255 French Creek Circle, Orono Soil Survey Information L, refer to attached soil survey Parent matl's' (] Till ❑ Outwash ❑ Lacustrine L Alluvium ❑ Organic J i3eCrock landscape position: U summit Shoulder Side slope Toe slope soil survey map units: slope ? °o direction- dowohill Soil Log 91 n Boring J Pit Elevation 105.9 Depth to SHWT 36" i)eluh tin} Texture tiaV�ment °o matrix color redox color consistence grade shape 0 - 12 loam I OYR 3:2 Friable Weak granular 12 - 18 clay loam 10YR 4 3 firm Moderate Prismatic t13 - 3 clay laun 10YR 54 Firm Moderate Prismanr 32 - 36 sandy loam 10YR 516 Friable Weak (iranular 36 - 48 sandy loam 1OYR 5l6 IOYR 6/8. 1 OYR 7'1 Friable 1A'eak granular Comments: 2255 French Creek Circle, Orono Soil Lot! 42 f �J Boring ] Pit Elevation 106.2 Depth to SHWT 26" Depth (in) Texlure tiagment °=a matrix color redox color consistence oracle ;hap 0 - 12 loam IQYR 3.2-IOYR4'3 Friable cal, t,ranuhr I W - 18 clay loam IQYR 513 Firm Moderate Prismatic 18 - 26 clay loam I OYR 5/6 1 irnn Moderate Prismatic 76 - 42 sandy loam H2O &2U I OYR 5. 3 1 OYR 6 '8 Friable t1't.}l Granular 42 - 4.3 loamy fine ,and 10Y"R 5!6 10YR 68 Loose 2255 French Creek Circle, Orono Soil Log #3 R Boring Ej Pit Elevation 106.7 Depth to SHWT 4011 U,pth (ill) "Texture fragment °6 matrix color redo -,'color consistence grade shape 0 - 18 loam IOYR3L2-IOYR 4/3 Friable Weak ciraimlar 18 - 34 clay loans i OYK 5 3 Finn Moderate Prismatic 34 - 38 fine sandy loam I OYR 5l6 Friable Wcak Granular 38 - 40 clay loam IQYR 5,'6 1 irm Moderatc Prismatic 40 - 48 sandy loam I OYR 4 3 i OYR 6 8 Friable Weak Granular I hereht• certify this work was completed in ocet)rdrmce with MN 7080 untl urn here)! req's Designer Signature Company Incense 4 4'D`1ro City of Orono Septic Asbuiit Form y � G Address: 2255 French Creek Circle Building Use: Residence Installer: Elmer J Peterson Co. License # L219 Date: 8/2/2017 Septic Tanks: 1 Pump Tank: 1300 Date Finaled: 8/2/2017 Bedrooms # 6 System Type: ❑X I II IN IX Mound Trenches Pressure Bed DOther Draw detailed diagram wAh measurements indicating distances to tank Risers. Use two(2) points from a permanent structure. Show locations of drop Boxes and length of trenches 1 2 3 a 5 6 7 8 9 10 11 12